Chest
Volume 129, Issue 4, April 2006, Pages 899-904
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Original Research
Impact of Pulmonary Rehabilitation on Psychosocial Morbidity in Patients With Severe COPD

https://doi.org/10.1378/chest.129.4.899Get rights and content

Study objective

To assess the effect of pulmonary rehabilitation (PR) on psychosocial morbidity, functional exercise capacity, and health-related quality of life (HRQL) in patients with severe COPD.

Design

A prospective, randomized, controlled trial with blinding of outcome assessment and data analysis.

Setting

A tertiary-care respiratory service.

Patients

Forty patients (mean age, 65 ± 8 years [± SD]) with severe chronic flow limitation (FEV1, 35 ± 13%) without respiratory failure (Pao2, 72 ± 9 mm Hg; Paco2, 42 ± 5 mm Hg) were randomized either to a control group or to a PR group (PRG).

Interventions

Sixteen weeks of PR that included breathing retraining and exercise.

Measurements

At baseline and 16 weeks, we evaluated psychosocial morbidity using two questionnaires (the Millon Behavior Health Inventory [MBHI] and the Revised Symptom Checklist [SCL-90-R]) and measured 6-min walk distance (6WMD) and HRQL using the Chronic Respiratory Questionnaire (CRQ).

Results

We found differences in favor of the PRG in the following MBHI domains: introversive, forceful, and sensitive personality styles (all p ≤ 0.05) and chronic tension (p ≤ 0.01). Results of the depression, hostility, global severity, positive symptom distress index (all p ≤ 0.01), somatization, anxiety, psychoticism, and positive symptom (all p ≤ 0.05) domains of the SCL-90-R favored the PRG. We also found statistically and clinically significant differences between groups in 6MWD (85 m; p < 0.01) and in two domains of the CRQ: dyspnea (1.0; p < 0.01) and mastery (0.6; p < 0.05). The other two domains of CRQ showed strong trends in favor of PRG: 0.7 for both fatigue and emotional function (minimal important difference, 0.5).

Conclusions

PR may decrease psychosocial morbidity in COPD patients even when no specific psychological intervention is performed. Findings from this study also confirm the positive impact of PR on functional exercise capacity and HRQL.

Section snippets

Patients

We enrolled consecutive eligible patients with COPD1 at our outpatient clinic. Inclusion criteria were as follows: age ≤ 75 years; FEV1 < 70% of reference values; FEV1/FVC ratio < 65%, Pao2 > 55 mm Hg at rest, no indications for home oxygen therapy, and no exacerbation or hospitalization in the previous 2 months. Exclusion criteria were psychiatric disturbances, heart disease, or relevant bone or joint disease. The hospital ethics committee approved the study, and all patients provided written

Results

We randomized 40 male patients aged 65 ± 8 years (mean ± SD). All patients had severe chronic airflow limitation with FEV1 of 35 ± 13% of the reference value and without respiratory failure (Pao2, 72 ± 9 mm Hg; Paco2, 42 ± 5 mm Hg). Five patients withdrew from the study, two patients in the PRG and one patient in the CG as the result of exacerbation during the first month; and two patients from the CG decided to abandon the study during the first weeks. The PRG was therefore made up of 18

Discussion

This study suggests that PR without a specific psychological intervention program can impact positively on psychosocial morbidity in patients with COPD. We found substantial differences between groups in favor of the PRG on some, but not all, domains of two questionnaires that address issues of psychosocial morbidity. In the questionnaire domains that failed to show significant differences, most favored the intervention group.

COPD is a progressive irreversible disease that, in its advanced

Acknowledgment

The authors thank Carolyn Newey for help with editing the text.

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